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President's Message

october 2023

Dear MDACC Members:

Heart House is a special place; the headquarters of our College and a space filled with energy and a tribute to the history of cardiology. Better yet - it is in our backyard and our Mid-Atlantic Capital Cardiology Symposium (MACCS), a one-day rapid fire format educational event, is where to enjoy this special place. MACCS is a meeting with debates and panel discussions that are designed to be interactive and engaging. Our CME/CNE environment is one with open discussion – Zoom has its place, but an in-person meeting is an experience.

MACCS starts on Saturday, November 18 with the Kick-off Cocktail at Heart House. Then on Sunday, November 19 the educational event takes place around the block at the Westin Georgetown. Thinking this could be a great family get-away weekend? We’ve got a special rate at the hotel and your guests are invited to the Kick-off Cocktail. Come for the CME/CNE, camaraderie, and energy. Click here to register - I look forward to seeing many of you!

Garima Sharma, MD, FACC

Governor, Maryland Chapter ACC

 

MDACC SUPPORTS CHANGES IN PRIOR AUTHORIZATION


Bills in both the Maryland House of Delegates and Senate have been introduced to reform prior authorization and step-therapy.  MDACC is supporting these reforms through letters, in-person testimony, and an email campaign to the membership.  See below for more details.

RE: SUPPORT FOR SB 308 Health Insurance – Utilization Review – Revisions and

SB 515 Health Insurance – Step Therapy or Fail First Protocol – Revisions

These bills target the unnecessary denial of health care services by health insurers. Commonly known as prior authorization or step therapy, these practices often delay or deny medications and services that have received clinical consensus through stringent vetting and are published and updated regularly in medical journals and literature.

Time is critical for cardiovascular patients. The sooner a cardiologist can treat and monitor a

patient, the more likely the patient is to recover and thrive. Unfortunately, insurer prior authorization program denials in Maryland are rising.

Increasingly, cardiovascular professionals use point of care tools (ACC Practice Tools) and other technological resources (NCDR National Cardiovascular Data Registry) to access information that provides update information that guides treatment decisions and helps them provide timely care.

  • In 2018, there were 78,314 denials based on medical necessity.
  • In 2021 that number increased to 81,143.
  • The Maryland Insurance Administration (MIA) ruled that in over 70% of complaints they received from patients, the denial was invalid, and that the patient should have received the health care service.

In 2021, an American Medical Association (AMA) survey revealed the following about the impact of prior authorization on physicians and patients:

  • 93% of physicians reported delays in access to necessary care.
  • 82% of physicians reported that patients abandoned recommended treatments because of prior-authorization denials.
  • 73% of physicians reported that criteria used by carriers for determining medical necessity is questionable - 30% of physicians reported that it is rarely or never evidence-based and 43% only sometimes evidence-based.
  • 88% of physicians describe the burden of prior authorizations as high or very high with 40% of physicians reporting that they have staff dedicated exclusively to prior authorizations.

Not only are these policies hurting patients, but they are hurting physicians, too.

The process to secure prior authorization is labor intensive, costly, and stressful. Surveys consistently reveal that undue administrative burden is a leading cause of physician burnout and depression.


The Maryland Chapter ACC supports the American College of Cardiology’s statement of support for the Ukrainian people; see this link for the full statement.



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Maryland Chapter, American College of Cardiology
1783 Forest Drive, Suite 238
Annapolis, MD 21401

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